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A comparative hospital-based observational study of mono- and co-infections of malaria, dengue virus and scrub typhus causing acute undifferentiated fever.
Eur J Clin Microbiol Infect Dis 2016; 35(4):705-11EJ

Abstract

Positive serology for dengue and/or scrub typhus infection with/without positive malarial smear (designated as mixed or co-infection) is being increasingly observed during epidemics of acute undifferentiated febrile illnesses (AUFIs). We planned to study the clinical and biochemical spectrum of co-infections with Plasmodium sp., dengue virus and scrub typhus and compare these with mono-infection by the same organisms. During the period from December 2012 to December 2013, all cases presenting with AUFIs to a single medical unit of a referral centre in Garhwal region of the north Indian state of Uttarakhand were retrospectively selected and categorised aetiologically as co-infections, malaria, dengue or scrub typhus. The groups thus created were compared in terms of demographic, clinical, biochemical and outcome parameters. The co-infection group (n = 49) was associated with milder clinical manifestations, fewer, milder and non-progressive organ dysfunction, and lesser need for intensive care, mechanical ventilation and dialysis as compared to mono-infections. When co-infections were sub-grouped and compared with the relevant mono-infections, there were differences in certain haematological and biochemical parameters; however, this difference did not translate into differential outcomes. Scrub typhus mono-infection was associated with severe disease in terms of both morbidity and mortality. Malaria, dengue and scrub typhus should be routinely tested in all patients with AUFIs. Co-infections, whether true or due to serological cross-reactivity, appear to be a separate entity so far as presentation and morbidity is concerned. Further insight is needed into the mechanism and identification of the protective infection.

Authors+Show Affiliations

Department of Medicine, Himalayan Institute of Medical Sciences, SRH University, Swami Ram Nagar, Jolly Grant, Dehradun, Uttarakhand, 248106, India. sohadia@hotmail.com.Department of Medicine, Himalayan Institute of Medical Sciences, SRH University, Swami Ram Nagar, Jolly Grant, Dehradun, Uttarakhand, 248106, India.Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, India.Department of Pediatrics, Himalayan Institute of Medical Sciences, Dehradun, India.Department of Pathology, Himalayan Institute of Medical Sciences, Dehradun, India.Department of Medicine, Himalayan Institute of Medical Sciences, SRH University, Swami Ram Nagar, Jolly Grant, Dehradun, Uttarakhand, 248106, India.Department of Community Medicine, Himalayan Institute of Medical Sciences, Dehradun, India.Department of Pathology, Himalayan Institute of Medical Sciences, Dehradun, India.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

26851948

Citation

Ahmad, S, et al. "A Comparative Hospital-based Observational Study of Mono- and Co-infections of Malaria, Dengue Virus and Scrub Typhus Causing Acute Undifferentiated Fever." European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, vol. 35, no. 4, 2016, pp. 705-11.
Ahmad S, Dhar M, Mittal G, et al. A comparative hospital-based observational study of mono- and co-infections of malaria, dengue virus and scrub typhus causing acute undifferentiated fever. Eur J Clin Microbiol Infect Dis. 2016;35(4):705-11.
Ahmad, S., Dhar, M., Mittal, G., Bhat, N. K., Shirazi, N., Kalra, V., ... Gupta, V. (2016). A comparative hospital-based observational study of mono- and co-infections of malaria, dengue virus and scrub typhus causing acute undifferentiated fever. European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, 35(4), pp. 705-11. doi:10.1007/s10096-016-2590-3.
Ahmad S, et al. A Comparative Hospital-based Observational Study of Mono- and Co-infections of Malaria, Dengue Virus and Scrub Typhus Causing Acute Undifferentiated Fever. Eur J Clin Microbiol Infect Dis. 2016;35(4):705-11. PubMed PMID: 26851948.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparative hospital-based observational study of mono- and co-infections of malaria, dengue virus and scrub typhus causing acute undifferentiated fever. AU - Ahmad,S, AU - Dhar,M, AU - Mittal,G, AU - Bhat,N K, AU - Shirazi,N, AU - Kalra,V, AU - Sati,H C, AU - Gupta,V, Y1 - 2016/02/06/ PY - 2015/11/17/received PY - 2016/01/18/accepted PY - 2016/2/8/entrez PY - 2016/2/8/pubmed PY - 2016/12/15/medline SP - 705 EP - 11 JF - European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology JO - Eur. J. Clin. Microbiol. Infect. Dis. VL - 35 IS - 4 N2 - Positive serology for dengue and/or scrub typhus infection with/without positive malarial smear (designated as mixed or co-infection) is being increasingly observed during epidemics of acute undifferentiated febrile illnesses (AUFIs). We planned to study the clinical and biochemical spectrum of co-infections with Plasmodium sp., dengue virus and scrub typhus and compare these with mono-infection by the same organisms. During the period from December 2012 to December 2013, all cases presenting with AUFIs to a single medical unit of a referral centre in Garhwal region of the north Indian state of Uttarakhand were retrospectively selected and categorised aetiologically as co-infections, malaria, dengue or scrub typhus. The groups thus created were compared in terms of demographic, clinical, biochemical and outcome parameters. The co-infection group (n = 49) was associated with milder clinical manifestations, fewer, milder and non-progressive organ dysfunction, and lesser need for intensive care, mechanical ventilation and dialysis as compared to mono-infections. When co-infections were sub-grouped and compared with the relevant mono-infections, there were differences in certain haematological and biochemical parameters; however, this difference did not translate into differential outcomes. Scrub typhus mono-infection was associated with severe disease in terms of both morbidity and mortality. Malaria, dengue and scrub typhus should be routinely tested in all patients with AUFIs. Co-infections, whether true or due to serological cross-reactivity, appear to be a separate entity so far as presentation and morbidity is concerned. Further insight is needed into the mechanism and identification of the protective infection. SN - 1435-4373 UR - https://www.unboundmedicine.com/medline/citation/26851948/A_comparative_hospital_based_observational_study_of_mono__and_co_infections_of_malaria_dengue_virus_and_scrub_typhus_causing_acute_undifferentiated_fever_ L2 - https://dx.doi.org/10.1007/s10096-016-2590-3 DB - PRIME DP - Unbound Medicine ER -